The Facial Skeleton in Patients with Osteoporosis: A Field for Disease Signs and Treatment Complications

Abstract

Osteoporosis affects all bones, including those of the facial skeleton. To date the facial bones have not drawn much attention due to the minimal probability of morbid fractures. Hearing and dentition loss due to osteoporosis has been reported. New research findings suggest that radiologic examination of the facial skeleton can be a cost-effective adjunct to complement the early diagnosis and the follow up of osteoporosis patients. Bone-mass preservation treatments have been associated with osteomyelitis of the jawbones, a condition commonly described as osteonecrosis of the jaws (ONJ). The facial skeleton, where alimentary tract mucosa attaches directly to periosteum and teeth which lie in their sockets of alveolar bone, is an area unique for the early detection of osteoporosis but also for the prevention of treatment-associated complications. We review facial bone involvement in patients with osteoporosis and we present data that make the multidisciplinary approach of these patients more appealing for both practitioners and dentists. With regard to ONJ, a tabular summary with currently available evidence is provided to facilitate multidisciplinary practice coordination for the treatment of patients receiving bisphosphonates.

Long-term treatment of osteoporosis: safety and efficacy appraisal of denosumab

“…No cases of atypical fractures have been reported in the trials after continuous administration of denosumab for up to 5 years 30. On the other hand, although extremely rare, the potential risk of osteonecrosis of the jaw is a major concern in patients treated with denosumab 64,65. Apart from several reports of denosumab-related osteonecrosis of the jaw in the literature, a pooled analysis in cancer patients with bone metastases quantified denosumab-related osteonecrosis of the jaw with a similar incidence (1.5%) to that of zoledronic acid66 and calculated the number needed-to-harm at approximately 70.…”

Novel Antimicrobial Agents for the Management of Maxillofacial and Neck Infections

“…Even without immunodeficiency, primary mycobacterial and actinomycotic osteomyelitis is a clinical reality. The authors have discussed different forms of osteomyeltitis in a previous publication [9]. Many bacteria that are commonly multidrug resistant, such as Staphylococcus aureus, Acinetobacter spp., and Pseudomonas aerouginosa, contribute to significant morbidity [5,7,[24][25][26][27].…”

“…However, anatomic anastomoses between the intracranial and extracranial venous systems also exist and therefore there is a potential route for the spread of infection from the orofacial area to the brain [9]. Those connections arise: a) around the orbits between the angular vein and the superior and inferior ophthalmic veins and b) between the pterygoid venous plexus and the cavernous sinus.…”

“…A wide range or organisms contributes to osteomyelitis as well [9]. Unlike long bone osteomyelitis, in which staphylococcal species predominate, the jaws are afflicted with a wide variety or pathogens, the most common of which are Streptococcus, Bacteroides, Lactobacillus, Eubacterium and Klebsiella.…”

“…The anatomical spaces are not completely isolated from one another and communications do exist between them [9]. Thus, infections located superficially often spread towards the deeper cervical spaces affecting vital structures such as the brain or the mediastinum [13], rendering the posterior layer of the deep cervical fascia (alar and prevertebral divisions) and its adjacent spaces (retropharyngeal and parapharyngeal) of outmost clinical importance [13].…”